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Relationship Obsessive Compulsive Disorder (ROCD): a Conceptual Framework

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Relationship Obsessive Compulsive Disorder (ROCD): a Conceptual Framework Journal of Obsessive-Compulsive and Related Disorders 3 (2014) 169–180 Contents lists available at ScienceDirect Journal of Obsessive-Compulsive and Related Disorders journal homepage: www.elsevier.com/locate/jocrd Relationship obsessive compulsive disorder (ROCD): A conceptual framework Guy Doron a,n, Danny S. Derby b, Ohad Szepsenwol a a School of Psychology, Interdisciplinary Center (IDC) Herzliya, P.O. Box 167, Herzliya 46150, Israel b Cognetica – The Israeli Center for Cognitive Behavioral Therapy, Tel Aviv, Israel article info abstract Article history: Obsessive compulsive disorder (OCD) is a disabling and prevalent disorder with a variety of clinical Received 11 July 2013 presentations and obsessional themes. Recently, research has begun to investigate relationship-related Received in revised form obsessive–compulsive (OC) symptoms including relationship-centered and partner-focused OC symp- 21 November 2013 toms. In this paper, we present relationship obsessive–compulsive disorder (ROCD), delineate its main Accepted 3 December 2013 features, and describe its phenomenology. Drawing on recent cognitive-behavioral models of OCD, social Available online 17 December 2013 psychology and attachment research, we present a model of the development and maintenance of ROCD. Keywords: The role of personality factors, societal influences, parenting, and family environments in the etiology Obsessive compulsive disorder and preservation of ROCD symptoms is also evaluated. Finally, the conceptual and empirical links Relationships between ROCD symptoms and related constructs are explored and theoretically driven assessment and Relationship obsessive compulsive disorder intervention procedures are suggested. Relationship-centered obsessions & Partner-focused obsessions 2013 Elsevier Ltd. All rights reserved. Attachment Self ROCD 1. Introduction David and Jane suffer from what is commonly referred to as relationship obsessive compulsive disorder (ROCD) – obsessive– David, a 32-year-old business consultant living with his partner compulsive symptoms that focus on intimate relationships. Obses- for 3 months, enters my office and describes his problem: “I0ve sive compulsive disorder (OCD) is an incapacitating disorder with been in a relationship for a year, but I can0t stop thinking about a wide variety of obsessional themes including contamination whether this is the right relationship for me. I see other woman on fears, fear of harm to self or others, and scrupulosity (Abramowitz, the street or on Facebook and I can0t stop thinking whether I will McKay, & Taylor, 2008). Relationship obsessive compulsive dis- be happier with them, or feel more in love with them. I ask my order (ROCD) refers to an increasingly researched obsessional friends what they think. I check what I feel for her over and over theme – romantic relationships. ROCD often involves preoccupa- again, whether I remember her face, whether I think about her tions and doubts centered on one0s feelings towards a relationship enough. I know I love my partner, but I have to check and recheck. partner, the partner0s feelings towards oneself, and the “rightness” I feel depressed. I can0t go on like this”. Jane, a 28 year-old of the relationship experience (relationship-centered; Doron, academic in a 2-year relationship, recently moved in with her Derby, Szepsenwol, & Talmor., 2012a). Relationship-related OC partner. She describes a different preoccupation: “I love my phenomena may also include disabling preoccupation with the partner, I know I can0t live without him, but I can0t stop thinking perceived flaws of one0s relationship partner (partner-focused; about his body. He does not have the right body proportions. I Doron, Derby, Szepsenwol, & Talmor., 2012b). ROCD symptoms know I love him, and I know these thoughts are not rational, he include a wide range of compulsive behaviors such as repeated looks good. I hate myself for having these thoughts, I don0t think checking (e.g., of one0s own feelings), comparisons (e.g., of looks are all that important in a relationship, but I just can0t get it partners0 characteristics with those of other potential partners), out of my head. The fact that I look at other men also drive me neutralizing (e.g., visualizing being happy together) and reassur- crazy. I feel I can0t marry him like this. Why do I always have to ance seeking. ROCD obsessions and associated compulsive beha- compare his looks to other men0s?”. viors lead to severe personal and dyadic distress and often impair functioning in individuals0 social, occupational or other important areas of life. n This paper outlines a theory of ROCD and reviews recent findings. Corresponding author. Tel.: þ972 9 960 2850. E-mail address: [email protected] (G. Doron). We argue that consideration of this obsessional theme may lead to a 2211-3649/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jocrd.2013.12.005 170 G. Doron et al. / Journal of Obsessive-Compulsive and Related Disorders 3 (2014) 169–180 broader understanding of the development and maintenance of The age of onset of ROCD is unknown. In our clinic, clients OCD, especially within a relational context. Relationship-related presenting with ROCD often report the onset of symptoms in early obsessive–compulsive symptoms may occur in various types of adulthood. In such cases, ROCD symptoms seem to persist relationships including people0s relationship with their parents, throughout the individuals0 history of romantic relationships. children, mentors, or even their God. In this paper, however, we Some individuals, however, trace back the onset of their ROCD will refer to ROCD within the context of romantic relationships. symptoms to the first time they faced commitment-related Consistent with prior OCD-related theoretical work (e.g. Doron & romantic decisions (e.g., getting married, having children). Kyrios, 2005; Rachman, 1997; OCCWG, 1997), we propose several Although ROCD symptoms can occur outside of an ongoing processes involved in the development and maintenance of ROCD romantic relationship (e.g., obsessing about past or future relation- and review initial evidence for their role in relationship obsessive– ships), such symptoms seem to be most distressing and debilitat- compulsive phenomena. We also argue that socio-cultural factors, ing when experienced in the course of an ongoing romantic early childhood environments, and parent–child relationships, influ- relationship. In community samples, ROCD symptoms were not ence the development of dysfunctional cognitive biases, self-percep- found to significantly relate to relationship length or gender tions, and attachment representations relevant to ROCD. Thus, this (Doron et al., 2012a,2012b; Doron, Szepsenwol, Karp, & Gal., 2013). paper aims to extend the focus of current OCD research by exploring The dyadic context provides abundant triggers of relationship- potential distal and proximal vulnerability factors that might con- centered and partner-focused OC phenomena. Nevertheless, for tribute to the development and maintenance of ROCD-related some individuals, ROCD symptoms may be activated by the dysfunctional beliefs and symptoms. termination of a romantic relationship. In this case, people may report being obsessively preoccupied with their previous partner “being the right one” and “missing the ONE”. Such cases are frequently associated with extreme fear of anticipated regret and 2. Relationship obsessive compulsive disorder (ROCD): are commonly accompanied by self-reassuring behaviors (e.g., phenomenology recalling the reasons for relationship termination), compulsive comparisons (i.e., with current partners), and compulsive recollec- ROCD is manifested in obsessive doubts and preoccupations tion of previous experiences (e.g., relationship conflicts). Other regarding romantic relationships and compulsive behaviors per- people report avoiding romantic relationships altogether for dread formed in order to alleviate the distress associated with the of hurting others (e.g., “I will drive her crazy”; “It will be a lie”)or presence and/or content of the obsessions. Relationship obsessions fear of re-experiencing ROCD symptoms. For instance, clients may often come in the form of thoughts (e.g., “is he the right one?”) report avoiding second dates for years for fear of obsessing about and images of the relationship partner, but can also occur in the the flaws of their partners or their partners becoming overly 0 form of urges (e.g., to leave one s current partner). Compulsive attached to them. behaviors in ROCD include, but are not limited to, repeated checking of one0s own feelings and thoughts toward the partner or the relationship, comparing partner0s characteristics or beha- 3. Measures of relationship obsessive–compulsive symptoms viors to others0, visualizing or recalling positive experiences or feelings, reassurance seeking and self-reassurance (see Table 1). A quick search on Google would show the term ROCD has been Relationship-related intrusions are often ego-dystonic as they frequently used in the last several years mainly on peer-support contradict the individual0s subjective experience of the relation- OCD forums. Systematic research, however, requires precise defi- ship (e.g., “I love her, but I can0t stop questioning my feelings”)or nitions and valid measurement tools. Recently, two measures were his or her personal values (e.g., “appearance should not be developed and validated for this purpose: the relationship obses- important in selecting
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